Intercostal nerve blockade with a mixture of bupivacaine and phenol enhance the efficacy of intravenous patient-controlled analgesia in the control of post-cholecystectomy pain

Abstract

Prolonged nerve conduction blockade has been proposed to result from the summed effects of charged and neutral local anaesthetics. Thirty-seven patients were randomly allocated to receive intravenous patient-controlled analgesia alone or combined with intercostal blockade (T7-T11) with a mixture of 0.45% bupivacaine and 0.6% phenol for post-cholecystectomy analgesia. Adequacy of pain relief was measured by patient scores on a 10-cm visual analogue scale and by dose-demand ratio, amounts of loading dose and total consumption of morphine and also the duration of patient-controlled analgesia in each group. No differences were found between groups in post-operative scores, dose-demand ratios and loading doses of morphine. However, in the combined treatment group, a significantly lower total consumption of morphine (P < 0.05), associated with a shorter duration of patient-controlled analgesia (P < 0.02) and a decreased mean number of unsuccessful demands (P < 0.001) were recorded. Intercostal blockade with bupivacaine-phenol supplements intravenous patient-controlled analgesia for post-cholecystectomy pain relief.

Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy

“…Because the type of anesthetic procedure and the time of surgery in both investigated groups were identical, we concluded that the pain reduction in our series was mainly attributable to INB. Our findings differ from those reported earlier for open cholecystectomies [9]. Thus, it might be assumed that the postoperative pain mechanisms after LC and open cholecystectomy are different [6,8,17].…”

“…Intercostals neural blockade is used in various conditions of acute and chronic pain affecting the thorax and upper abdomen (e.g., postoperative analgesia after thoracotomies [15] and open cholecystectomies). It has been recommended as a complement to systemic morphine injections in the latter [9]. Its advantages are superior analgesia, opioid sparing, improved pulmonary mechanics, reduced central nervous system depression, and avoidance of urinary retention.…”

“…In 1995, SchulteSteinberg showed the statistically significant effect of interpleural bupivacain injection 6 h after the LC [13]. In 1998, Maidasti et al [9], using bupivacain, showed the good effect of intercostals neural blockade (INB) (T7-T11) on open cholecystectomy and recommended INB as a complement to the postoperative intravenous morphine injection. In 2003, Vieira et al [16] used interpleural bupivacain injection and INB with bupivacain, respectively, for two groups undergoing open cholecystectomy, with significant pain relief in both groups.…”

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

“…It has been shown that continuous intercostal nerve blocks lead to better pain control in these patients. 158 For patients undergoing laparoscopic cholecystectomy, pain severity 159 and postoperative morphine consumption 160 were significantly reduced by intercostal nerve blockade. In addition, the duration of the need for patient-controlled analgesia was significantly decreased.…”

“…In addition, the duration of the need for patient-controlled analgesia was significantly decreased. 160 With open cholecystectomy, intraoperative inhalation anaesthetic use was significantly reduced by the use of intercostal nerve blocks. 161 In cardiac surgery 162 163 and after major lung resections, 164 pain scores were significantly improved with a lower systemic analgesic requirement when compared with placebo.…”